基于潜在剖面分析住院老年慢性心力衰竭患者跌倒风险感知类别的研究

Research of categories of fall risk perception of elderly inpatients with chronic heart failure based on latent profile analysis

目的基于潜在剖面分析住院老年慢性心力衰竭(CHF)患者跌倒风险感知类别及其影响因素,为提高住院老年CHF患者跌倒风险感知提供参考。方法便利抽样法选取南京鼓楼医院老年科于2022年12月至2023年7月收治住院的老年CHF患者作为调查对象,采用基本情况问卷、医院焦虑抑郁量表、多维度慢性病自我管理效能量表、护患关系信任度量表和患者跌倒风险感知量表对其进行横断面调查,选择潜在剖面分析其跌倒风险感知类别,无序多分类Logistic回归分析不同类别患者跌倒风险感知影响因素。结果最终调查279例患者,其中男148例,女131例,年龄60~78(68.58±6.37)岁。住院老年CHF患者跌倒风险感知为(42.12±13.74)分,老年CHF患者跌倒风险感知类别中低风险感知组占12.55%(35/279)、身体风险感知组占17.20%(48/279)、环境风险感知组占56.99%(159/279)和高风险感知组占13.26%(37/279)。无序多分类Logistic回归分析结果显示,以高风险感知组为参考,男性、无跌倒经历、自我管理效能和护患信任度是低风险感知组住院老年CHF患者跌倒风险感知的显著影响因素(OR值为0.023~55.980,均P<0.05);不伴有其他慢性病、病程<5年、病程5~10年、自我管理效能和护患信任度是身体风险感知组住院老年CHF患者跌倒风险感知的显著影响因素(OR值为0.027~1.711,均P<0.05);住院时间<7 d、住院时间7~14 d、视力不正常、自我管理效能和护患信任度是环境风险感知组住院老年CHF患者跌倒风险感知的显著影响因素(OR值为0.907~6.482,均P<0.05)。结论住院老年CHF患者跌倒风险感知处于相对较低水平,可分为低风险感知组、身体风险感知组、环境风险感知组和高风险感知组,其跌倒风险感知水平受到性别、跌倒经历、伴有其他慢性病、病程、住院时间、视力不正常、自我管理效能和护患信任度影响,临床医护人员应针对不同类别住院老年CHF患者进行健康教育,提高其跌倒风险感知水平。

Objective To analyze categories and influencing factors of fall risk perception of elderly inpatients with chronic heart failure(CHF)based on latent profile analysis for providing references on improving their levels of fall risk perception.Methods During December 2022 and July 2023,the elderly inpatients with CHF were selected as survey subjects through convenience sampling from department of geriatrics of Nanjing Drum Tower Hospital,and they were taken a cross-sectional investigation using a general information questionnaire,Hospital Anxiety Depression Scale,Multidimensional Chronic Disease Self-management Effectiveness Scale,Nurse-patient Trust Scale and Fall Risk Perception Questionnaire for Patients.Their categories of fall risk perception were analyzed by latent profile analysis.The influence factors of their different categories of fall risk perception were analyzed by unordered multi-class Logistic regression analysis.Results There were 279 patients in final investigation,which contained 148 males and 131 females,and their age were during 60 to 78(68.58±6.37)years old.The score of fall risk perception of elderly inpatients with CHF was(42.12±13.74).Among the fall risk perception categories of elderly CHF patients,the percentage of patients low risk perception group was 12.55%(35/279),percentage of patents from physical risk perception group was 17.20%(48/279),percentage of patents from environmental risk perception group was 56.99%(159/279)and percentage of patents from high risk perception group was 13.26%(37/279).Compared to high-risk perception group,unordered multi-class logistic regression analysis showed that male,no fall experience,self-management effectivenessand level of patient′s trust on nursewere significant influencing factors of fall risk perception of low risk perception group(OR values were 0.023-55.980,all P<0.05);no having other chronic diseases,less than 5 years long course of disease,5 to 10 years long course of disease,self-management effectiveness and level of trusting nurse were significant influencing factors of fall risk perception of physical risk resulting in perception group(OR values were 0.027-1.711,all P<0.05);less than 7 days long hospital stay,7 to 14 days long hospital stay,abnormal vision,self-management effectiveness and level of patient′s trust on nurse were significant influencing factors of fall risk perception of environmental risk resulting in perception group(OR values were 0.907-6.482,all P<0.05).Conclusions The level of fall risk perception of elderly inpatients with CHF was low and could be divided into low risk perception group,physical risk perception group,environmental risk perception group and high risk perception group.Their fall risk perception was influenced by gender,fall experience,having chronic diseases,course of disease,hospital stay,abnormal vision,self-management effectiveness,and level of patient′s trust on nurse.Clinical medical staff should provide personalized health education to different categories of fall risk perception of elderly inpatients with CHF,in order to improve their level of fall risk perception.